Prostate cancer has overtaken breast cancer in cancer statistics. Hormonal drugs are an important means of stopping the progress of the disease, which mainly affects older men. The drugs usually make the disease dormant.
Prostate cancer According to Professor Teuvo Tammela, Chairman of Deptartment of Urology at Tampere University Hospital, Finland, each prostate cancer case is different. Suitable treatment depends on the degree of spreading and aggressiveness of the cancer as well as the age and general condition of the patient.
“If the cancer tumour is local and the patient is under 70, the prostate is removed or treated by radiation therapy. If the prostate cancer is local and the prognosis is good, it is sometimes sufficient to keep monitoring the illness. In such cases, surgery or radiation therapy is necessary only if the disease progresses or becomes more serious,” Professor Tammela explains.
Testosterone production
must be stopped
The cancer tumour requires the male sex hormone, testosterone, to be able to develop and spread. The testosterone production in the testicles can be stopped by a surgical operation or by medication.
“Typically, hormonal medication uses so-called LHRH analogues as a chemical means of preventing testicles from producing testosterone. If the hormone treatment uses so-called anti-androgens, the patient’s own hormone production is not prevented, but testosterone is blocked from reaching the receptors of the cancer cells. This prevents testosterone from increasing the growth of the cancer cells. In some cases, patients can also be treated with female sex hormones,” says Professor Tammela.
Hormone medication
improves the quality of life
If the cancer has already spread beyond the prostate, in which state it may be causing bone ache or blocking urine flow, it can be made dormant with hormone treatment. This improves the patient's quality of life.
“If testosterone production is stopped with LHRH analogs, the prostate decreases in size and the urination problems ease up. This will also ease the pain caused by possible metastatic tumours. Anti-androgen treatment is less effective than castration treatment if the cancer has spread to bones.”
According to Professor Tammela, hormone treatment can be used in conjunction with surgery and radiation therapy. It is sometimes used as the only means of treatment when the tumour has spread locally.
Hormone medication is available as tablets, injections and capsules implanted under the skin.
“The benefit of implanted capsules is the steady release of the medicine. Placing the capsule takes just a few minutes at the doctor's office. With injections, the treatment intervals are usually 1, 3 or 6 months, and the patient has to visit the doctor's office. The suitable form is determined by the kind of treatment. Injections or implanted capsules are used in medical castration,” says Professor Tammela.
Erectile dysfunction
as an adverse effect
Surgery, radiation therapy and hormone therapy often cause impotence. Of patients under 60 having not suffered from erectile dysfunction before the surgery, 80 per cent can get an erection, at least with the help of medication.
Anti-androgen treatment does not usually have an effect on a man’s ability to get an erection because it does not decrease the level of testosterone. Possible side effects of anti-androgens include tenderness and enlargement of breasts (gynecomastia).
Treatments which lower the level of testosterone may weaken bones and muscles. Patients should exercise regularly and make sure they get enough calcium and vitamin D. Hot flushes are common among patients.
Surgery and radiation therapy may also cause urinary incontinence.
Could robotic technologies
be beneficial?
According to Professor Tammela, treatment methods keep evolving.
“The use of robotic technologies is becoming more common because patients recover very quickly and the risk of complications is reduced in robotic surgeries.”
Both the Tampere and Helsinki University Hospitals perform robotic prostatectomies.
“Hormone treatments have a lot of unleashed potential, too. In the future, it may also be possible to perform local procedures with a technology which fires radiation to the cancer tissue with pinpoint precision without damaging the surrounding tissue," Professor Tammela predicts.
Screenings are
a double-edged sword
The discussion about whether large-scale screenings should be organized among the population due to the high levels of prostate cancer has been lively recently.
“This is a controversial question. Although it is has been proven that Prostate-Specific Antigen (PSA) blood tests and screenings can reduce prostate cancer mortality by 20 to 28% in 9 years, the problem is ─ in addition to cost-efficiency ─ that such screenings would also find numerous cases which would not require any kind of treatment. Knowledge of the disease would cause unnecessary pain and anguish for many,” Professor Tammela says and concludes that the current situation does not yet warrant population-based prostate cancer screening.
Text Matti Välimäki | Photos Rami Marjamäki